NPIMap

Individual provider Active NPI

Misty Marlene Anthony-McAllister, PA-C, MPAS

  • Physician Assistant
  • Shreveport, LA
National Provider Identifier
1740646355
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
300091 Issued in LA
Practice address
510 E Stoner Ave
Shreveport, LA 71101-4243
Phone
(318) 221-8411
NPI assigned
Jan 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 300091 LA Primary

Addresses

Primary practice location

510 E Stoner Ave
Shreveport, LA 71101-4243

Mailing address

510 E Stoner Ave
Shreveport, LA 71101-4243
Phone (318) 221-8411

Other practice location 1

1549 E 70th St Ste 300
Shreveport, LA 71105-5056
Phone (318) 300-3898

Other identifiers 12

IdentifierTypeStateIssuer
13653665OtherCAQH
2645976OtherWELLCARE
7771259OtherMULTIPLAN (PHCS)
QZZ000000106926OtherAETNA BETTER HEALTH
6261862OtherAETNA
0246933OtherCIGNA
1740646355OtherHEALTHY BLUE
2869917OtherFIRST HEALTH
60326536OtherLAAMERIHEALTH CARITAS
1740646355OtherLALA HEALTHCARE CONNECTIONS
2424076MedicaidLA
146475OtherVANTAGE HEALTH PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160210000526 LA Practitioner - Physician Assistant 5597069641 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arklatex Medical Consultants a Medical Corporation 16 clinicians

Practice addresses (Care Compare)

1549 E 70TH St
Suite 300
Shreveport, LA 71105-5056
Phone (318) 300-3898

8731 Park Plaza Dr
Shreveport, LA 71105-5682
Phone (318) 797-5848

Hospital & facility affiliations

  • Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041
  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
300091LAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arklatex Medical Consultants a Medical Corporation CurrentSince Nov 30, 2018 Accepting new patients
Arklatex Medical Consultants a Medical Corporation Physician Assistant CurrentSince Nov 30, 2018 Accepting new patients

Locations

1549 E 70th St
Ste 300
Shreveport, LA 71105
Phone (318) 300-3898

8731 Park Plaza Dr
Shreveport, LA 71105
Phone (318) 524-7144

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BCHDDD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1740646355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 E STONER AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014243",
            "telephone_number": "318-221-8411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E STONER AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014243",
            "telephone_number": "318-221-8411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1549 E 70th St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055056",
            "country_code": "US",
            "telephone_number": "318-300-3898",
            "fax_number": "318-797-4241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTHONY-MCALLISTER",
        "first_name": "MISTY",
        "middle_name": "MARLENE",
        "credential": "PA-C, MPAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-12",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "300091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13653665",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "2645976",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN (PHCS)",
            "identifier": "7771259",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BETTER HEALTH",
            "identifier": "QZZ000000106926",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "6261862",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0246933",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY BLUE",
            "identifier": "1740646355",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "2869917",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH CARITAS",
            "identifier": "60326536",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA HEALTHCARE CONNECTIONS",
            "identifier": "1740646355",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2424076",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VANTAGE HEALTH PLAN",
            "identifier": "146475",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.